It might be a tricky journey: Wiltshire CCG sets out to tender a £43 million a year contract now held by GWH

Written by Tony Millett.


If you wanted to put a magnifying glass to the coalition government’s NHS restructuring there was no better place to do it than at the November board meeting of the Wiltshire Clinical Commissioning Group (CCG) held in Salisbury on Tuesday (November 25.)

The clinicians, directors and staff spent a long time considering the forthcoming procurement process for the county’s adult community services (ACS for short.) This contract is currently held by the Great Western Hospitals Foundation Trust.  

The winner of the new five year contract (possibly even a seven year contract) must be ready to begin work on 1 July 2016 and this means the process of selecting provider and/or providers must start on 5 January.  The contract will be worth about £43 million a year.

The CCG’s finance director, Simon Truelove, explained why they had decided on a long contract period: “If we want providers to invest in our services, a short contract is quite a turn off.”

This contract is central to the CCG’s ambitions in its five year plan and in the Better Care Plan for the frail elderly it will be running with Wiltshire Council next year.  The aim is to move more care – especially of the elderly – to people’s homes and lessen the need for hospital admissions.

To do this the CCG is already implementing a sophisticated system of care in the community – building on the community care system they inherited from the Primary Care Trust in April 2013.

Those interested in bidding for this ACS contract will have to address two levels of specification: termed the “As Is” and the “To Be”.  One of the many complications is that the “As Is” is a moving target – it is developing all the time as GWH works with the CCG to increase and refine the community teams based across the county.

A preferred bidder will be announced in a year’s time and the contract awarded in December 2015.  

The CCG have decided not to run a consultation process on the contract: "We don't consider formal consultation to be necessary at this time."  They argue the contract will not bring radical changes to services and the public have already been told about the Five Year Plan and the Better Care Plan which rely on upgraded community services.

The CCG’s meeting came the day after the Health Service Journal reported the High Court ruling that NHS England has been acting unlawfully by failing properly to involve and inform patients about its decisions in commissioning primary care – mainly the GP service.

This could leave NHS England open to legal challenge on eighteen months of decisions.  NHS England had conceded to the court it had acted unlawfully and said it was ‘taking active steps to bring itself into compliance with this duty.’

It is by no means clear that all CCGs will go ahead with every procurement.  Or they may simply decide to name an NHS body as their preferred bidder.

Tendering under the Lansley Health and Social Care Act inevitably opens up the issue of NHS privatisation.

It is undeniable that privatisation has been proceeding apace.  Recent analysis makes it clear that private health firms have won two out of three of the 195 contracts awarded by NHS bodies in England since the Lansley legislation significantly  extended mandatory tendering of services.  

Moreover private firms have won about half the value of those 195 deals so far agreed.  At a 50 per cent hit rate, private firms could win contracts worth £6.6 billion of the £13 billions worth of contracts already advertised but still to be awarded.

Commenting on this trend towards privatisation, Dr Mark Porter, chair of council at the British Medical Association, is emphatic: "An act that the government denied loud and long would lead to privatisation, has done exactly that."

However, despite coalition MPs continued claims that it is a myth they intend to privatise the NHS (“First can I make it absolutely clear that the Government is NOT planning on privatising the NHS” - Claire Perry MP), there is much evidence to back Dr Porter's assertion.

The contract figures quoted above and the words of the Lansley Act itself (now admitted by a Cabinet minister to have been the coalition’s ‘biggest mistake’) belie coalition claims.  And if privatisation was not their aim, why were the Clinical Support Units set up to become independent so they could be sold off (revealingly, this manoeuvre has now been postponed until after the election)?  

Why was the new NHS Property company set up so it could be sold off and then be able to undermine front line services by increasing the rents it charges for its buildings? Why was NHS Direct binned so that private groups could apply for - and often win - so many of the NHS 111?

Of more immediate concern may be the costs of the tendering system.  The Daily Mirror has unearthed figures showing that the hospitals in England are spending up to £60 million a year bidding for contracts. That cannot be a sensible way to protect front line services.

It will be interesting to watch Wiltshire CCG’s ACS procurement process.  Amongst other things it will have to deal with what were called at the board meeting the ‘shifting sands of government policy’.  And it must find a ‘lead provider’ who will be “responsible for managing an entire care pathway and sub-contracts with other providers for part of the pathway.”

This may become a feature of these big contract tenders: the CCG have restricted funds for running costs (or overheads) and this sum will shrink next year.  This is why some CCGs are putting their tender costs against front line budget lines as being integral to provision of the services.

The CCG is being very careful to avoid any conflicts of interest that its GP directors may have with any of the potential providers.  There are risks "associated with legal challenge resulting from conflicts of interest through the inherent structure of the CCG with its GP providers as members and leaders."

That is just one of several crucial risks the CCG faces along the way.

There is one risk for the Marlborough area in the outcome of this tender process: if GWH do not hold onto the contract, what will happen to Savernake Hospital which GWH now own and which has become a key part of GWH’s provision of community care services?  So Marlborough News Online will be keeping a careful eye on the process.